Congress Seeks Study of Resident Duty Hours

Medical resident duty hours may come under the microscope again as a result of a request from Congress that the Agency for Healthcare Research and Quality, or AHRQ, fund an Institute of Medicine study into the issue.

The request came in a letter from House Energy and Commerce Committee Chair John Dingell, D-Mich.; Ranking Member Joe Barton, R-Texas; Oversight and Investigations Subcommittee Chair Bart Stupak, D-Mich.; and Ranking Member Ed Whitfield, R-Ky.

"The Committee requests that AHRQ assist us in ascertaining if the long work hours of physicians and residents also are among the most serious threats to patient safety," the congressmen wrote in a March 29 letter (PDF file: 2 pages / 127 KB. More about PDFs.) to William Munier, M.D., acting director of AHRQ.

In the letter, the congressmen cite a December 2006 study, "Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attention Failures," that concludes work shifts extending beyond 16 hours can increase the number of medical errors.

Conducted between July 2002 and May 2003, the study found "extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events and attentional failures in interns across the United States." The researchers also concluded that long work shifts had negative effects on education because residents in the study reported falling asleep during patient encounters and educational activities.

Questions regarding patient safety and resident duty hours have dogged medical education for years. In response to research demonstrating a causal link between resident fatigue resulting from long work shifts and the risk for medical errors, the Accreditation Council for Graduate Medical Education, or ACGME, implemented new rules (PDF file: 9 pages / 220 KB. More about PDFs.) that stipulate that, averaged over a four-week period, residents cannot be scheduled for more than 80 hours per week; one day in seven must be free of patient care responsibilities; and in-house call can be scheduled no more frequently than every third night.

In addition, in-house call duty must be limited to 24 hours, with an added period of as much as six hours for continuity, educational debriefing and didactic activities. Finally, residents must have a minimum 10-hour rest between duty periods.

Those restrictions, however, have forced family medicine residency programs to eliminate post-call clinics, institute night-float systems and, in some cases, hire additional staff members, according to research in the December issue of Academic Medicine.

"Many family medicine program directors cited increased faculty burden and the risk of lower-quality educational experiences for their trainees," the study authors wrote in their abstract of the article, "Training on the Clock: Family Medicine Residency Directors' Responses to Resident Duty Hours Reform."